The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever

Giovanna Stringari, Salvatore Tripodi, Carlo Caffarelli, Arianna Dondi, Riccardo Asero, Andrea Di Rienzo Businco, Annamaria Bianchi, Paolo Candelotti, Giampaolo Ricci, Federica Bellini, Nunzia Maiello, Michele Miraglia Del Giudice, Tullio Frediani, Simona Sodano, Iride Dello Iacono, Francesco Macrì, Ilaria Peparini, Carlotta Povesi Dascola, Maria Francesca Patria, Elena VarinDiego Peroni, Pasquale Comberiati, Loredana Chini, Viviana Moschese, Sandra Lucarelli, Roberto Bernardini, Giuseppe Pingitore, Umberto Pelosi, Mariangela Tosca, Anastasia Cirisano, Diego Faggian, Alessandro Travaglini, Mario Plebani, Paolo Maria Matricardi

Research output: Contribution to journalArticlepeer-review

Abstract

Background Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources. Objectives We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR. Methods Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA2LEN-European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists. Results No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69%]), Betulaceae (146/252 [60%]), pellitory (78/257 [30%]), olive (111/390 [28%]), cypress (28/184 [15%]), and grass (56/568 [10%]). IgE to profilins, polcalcins, or both could justify 173 (37%) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42%) of 651 or 315 (48%) of 651 children according to the European or American approach, respectively, and in 305 (47%) of 651 children according to the opinion of the 14 local pediatric allergists. Conclusions In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.

Original languageEnglish
JournalJournal of Allergy and Clinical Immunology
Volume134
Issue number1
DOIs
Publication statusPublished - 2014

Keywords

  • Allergic rhinitis
  • children
  • component-resolved diagnosis
  • IgE
  • panallergens
  • pollen
  • profilin
  • specific immunotherapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Medicine(all)

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